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Article |

Cesarean Births and Trial of Labor Rates

Leslie Iffy, MD
JAMA. 1987;257(20):2757. doi:10.1001/jama.1987.03390200097016.
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To the Editor.—  The article by Shiono et al1 concludes that the National Institute of Child Health and Human Development—sponsored Consensus Development Conference on Cesarean Childbirth2,3 failed to affect the increasing rates of abdominal deliveries in general, and repeated cesarean sections in particular. A similar experience has been reported from this institution, where the cesarean-section rate increased from about 12% to 15% between 1980 and 19834 and has climbed higher since.The authors note that "virtually all of the hospitals surveyed were able to prepare for an emergency cesarean within 30 minutes." I still feel uncertain what a 30-minute start-up time means. When the obstetric operating rooms are empty, we in this center can invariably start a cesarean section within 30 minutes. However, with one room (and team) already engaged, it is not always possible, and when two operations are already in progress, it is rarely possible


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